Use Permit
Submittal Requirements
The following must be submitted with your Use Permit Application:
1.
2.
3.
4.
5.
6.
7.
8.
Development Application — signed by applicant and property owner
Supplemental Forms (Attachments A, B, C, D & E)
Site & Architectural Plans —Refer to Attachment A for items to be shown on plans
a.
Four (4) full-size sets (24” x 36”) Must fold to 8 1/2” X 11” size
b.
One (1) reduced set (11” x 17”)
c.
PDF format plans on CD in the following format(s):
 8 ½ ” x 11” scale / 150 dpi / PNG images
 24” x 36” scale / 300 dpi / JPEG or PNG images
d.
Note that additional reduced sets (and an updated PDF set on CD) will be required
following review of the original submittal in preparation of the public meeting.
Sample Board: Provide two (2) color copies (8 ½ “ x 11”) of photo representations of
construction materials and exterior paint colors. If the permit involves an addition to an existing
structure and the materials proposed will match existing, the plans should state this on the building
elevations.
Written Statement — Describe the requested project in detail and give reasons why the permit
should be granted. Information should include the nature of the use, type of operation, potential
traffic generation, potential noise generation, hours of operation, and number of employees.
Photographs — Photos of existing site and building and surrounding uses (include on the
submitted CD)
Preliminary Title Report
Filing Fee
Planning Division Fees
______ $3,904 - Use Permit
______ $1,899 - Massage Therapy or Large Family Day Care
______ $4,871 - Wireless Facilities
______ 50% of original fee - Modification to a previous Use Permit
______ $350 - Single-Family Residence Designated Landmark Alteration
______ $214 - Environmental Categorical Exemption (fee may be increased pending
environmental determination)
Fire Department Fee
______ $265 for Project Plan Review
NPDES Review Fees (C-3 requirements)
_____ $163 for projects less than 10,000 s.f. impervious area
_____ $704 for Special Land Use projects more than 5,000 s.f. impervious area
_____ $704 for projects between 10,000 s.f. to 1 acre impervious area
_____ $918 for projects more than 1 acre impervious area
*Receipt must be submitted to the Planning Division
The staff planner who is on duty when your application is submitted will give the application a cursory review for
completeness. If any of the above items are not complete, the application will not be accepted. Applications for
Modifications to a previous Use Permit approval may not require all of the above items to be submitted. Please
review your application with a staff planner, so that he/she may determine what items must be submitted.
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Development Application
FILE NO:___________________
Planning Division - City of Campbell - 70 N. First Street, Campbell, California 95008 (408) 866-2140
PROJECT LOCATION:_________________________________________
(Address)
_______________________
(Assessor’s Parcel Number)
GENERAL PROJECT DESCRIPTION:________________________________________________________
__________________________________________________________________________________________
ZONING:_______________________________ GENERAL PLAN:_________________________________
APPLICANT INFORMATION:
NAME:
ADDRESS:
TELEPHONE:
CITY/STATE:
CELL:
EMAIL:
ZIP:
PROPERTY OWNER INFORMATION:
NAME:
ADDRESS:
TELEPHONE:
CITY/STATE:
CELL:
EMAIL:
ZIP:
Attach a separate sheet listing any additional people to receive copies of reports and agendas.
AFFIDAVIT/SIGNATURE(S):
The undersigned person(s), having an interest in the above-described property, hereby make this application in
accordance with the provisions of the Campbell Municipal Code; and, hereby certify that the information given
herein is true and correct to the best of my/our knowledge and belief.
________________________________
Applicant’s Signature
Date
_______________________________
Property Owner’s Signature
Date
The City will review the application for completeness and will notify the applicant within 30 days of submittal of a complete or
incomplete application.
Types of Application(s) - Check off all that apply for this project:
Administrative Planned Development Permit
Administrative Site and Architectural Review Permit
Extension of Approval
Fence Exception
Environmental Impact Report Review
Fire Review
General Plan Amendment
Heritage Tree Designation
Home Occupation Permit
Initial Study/Negative Declaration
Landmark Designation
Alteration to Designated Landmark
Minor Modifications to Side Yard Setback (residential)
Modifications
Outdoor Seating and Display Permit
Parcel Map (four lots or fewer)
Planned Development Permit
Pre-Application (Tier 1 or Tier 2)
Reasonable Accommodation
Sign Application - Single Sign
Signs - Additional Signs per business filed at
same time
Signs - Program - (five or more signs)
Signs - Downtown (C-3) Exceptions
Signs - Exception
Signs - Freeway Oriented
Site and Architectural Review Permit
Subdivision Map (five lots or more)
Temporary Sign(s)
Tree Removal Permit
Use Permits
Underground Utility Waiver
Variance
Zoning Certification Letter
Zone Change
Attachment A
Items to be Provided on Plans
A. VICINITY MAP:
Showing the location of the site within the City (1/4 mile radius).
B. PLOT PLAN CLEARLY SHOWING:
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
Scaled site plan indicating property dimensions (reference recorded map if applicable).
North arrow
Distance from centerline of adjacent street(s) to property line(s).
Proposed or existing street improvements dimensioned from the centerline of the street
(curb, gutter, sidewalks, driveways, existing street tree, etc.).
Recorded or proposed easements/dedications.
Location of proposed building(s) or existing building(s) to remain.
Indicate all setbacks from property lines and distances between buildings/structures.
Existing or proposed driveways and other proposed ingress/egress design.
Parking/loading — location and dimension of spaces and aisles as specified in Chapter
21.28 of the Zoning Code.
Proposed exterior lighting
Pedestrian, vehicular, and service points of ingress and egress, driveway widths.
Paved areas — indicate proposed walkways, patios, and disabled access.
Fencing, including retaining walls, existing and/or proposed to be shown (type, height, and
materials).
Provide location and uses of buildings on adjacent properties.
Show location/design of trash enclosures, utility transformers and meters necessary to
service the proposed use.
Indicate public transit stops and bicycle/motorcycle facilities when appropriate.
Provide a preliminary grading and drainage plan indicating existing and proposed grades
relative to existing natural grade or top of curb. Submit calculations that are consistent with
the submitted grading plans that show the proposed project will meet storm water requires
pertaining to the City’s NPDES Permit C.3 provisions (flow based or volume based on-site
design measures).The proposed plan should show storm water on-site treatment elements.
C. ELEVATIONS -- FRONT, SIDES AND REAR, INDICATING:
1)
2)
3)
4)
5)
6)
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Dimensions of all buildings.
Height of all buildings.
Roof Plans including roof pitch, potential heating, ventilation, air conditioning (HVAC)
systems with appropriate screens.
Existing and proposed construction.
Building materials.
Color of proposed and existing buildings.
Attachment A - Items to be Provided on Plans
Page 2
D. FLOOR PLAN(S)
1)
2)
Floor plan for each level (existing and/or proposed).
Finished floor elevation of first floor relative to existing natural grade or top of curb.
E. BUILDING CROSS-SECTIONS
1)
2)
Relative to top of curb.
Relative to structures on adjoining properties.
F. LANDSCAPE PLAN
Landscaping — conceptual landscape plan indicating existing and proposed landscaping. Show
all existing trees on site and indicate which trees are proposed to be removed or retained.
Indicate the trunk diameter, tree drip line and tree type for all trees over 12” in diameter
measured at 4 feet above grade.
G. STREETSCAPE
A streetscape of the proposed project which illustrates the proposed buildings and the adjacent
buildings on either side as viewed from the street.
H. PROJECT SUMMARY
Please see the attached worksheet. This information must be provided either on the title sheet or
site plan, in addition to the supplemental application form.
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Attachment A - Items to be Provided on Plans
Page 3
PROJECT SUMMARY
-
ASSESSORS PARCEL NUMBER:
-
LOT SIZE:
Gross sq. ft. (Property to center line of street)
Net sq. ft.
Square Feet
Existing
Proposed
DEVELOPMENT DATA:
Percent of Site
Existing
Proposed
Building coverage
Landscape coverage
Paving coverage
FLOOR AREA RATIO: Total bldg s.f.
divided by net lot size
ADJACENT LAND USES:
Use
North
South
East
West
PARKING:
# Standard Spaces
# Compact Spaces
# Disabled Spaces
# TOTAL PARKING
RESTAURANT AND ASSEMBLY USES:
Seating Count
RESIDENTIAL PROJECTS:
UNIT TYPE
A
Living Area (square footage)
Garage Area (square footage)
Total Area (square footage)
Number of Bedrooms
Total Number of Units per Type
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UNIT TYPE
B
UNIT TYPE
C
UNIT TYPE
D
Attachment B
Planning Commission Contribution Disclosure Form
INFORMATION SHEET
This form must be completed by applicants for, or persons who are the subject of, any proceeding involving a license, permit,
or other entitlement for use pending before the Planning Commission.
Important Notice: Basic Provisions of the Government Code Section 84308
I.
If you are an applicant for, or the subject of, any proceedings involving a license, permit, or other entitlement for use,
you are prohibited from making a campaign contribution of $250 or more to any commissioner, his or her alternate, or
any candidate for such position. This prohibition begins on the date your application is filed or the proceeding is
otherwise initiated, and the prohibition ends three months after a final decision is rendered by the Planning
Commission. In addition, no commissioner, alternate, or candidate may solicit or accept a campaign contribution of
$250 or more from you during this period. These prohibitions also apply to your agents, and, if you are a closely held
corporation to your majority shareholder as well.
II.
You must file the attached disclosure form and disclose whether you or your agent(s) have in the aggregate contributed
$250 or more to any commissioner, his or her alternate, or any candidate for the position during the 12-month period
preceding the filing of the application or the initiation of the proceeding.
III.
If you or your agent have made a contribution to any commissioner, alternate, or candidate during the 12 months
preceding the decision on the application or proceeding, that commissioner must disqualify himself or herself from the
decision. However, disqualification is not required if the commissioner, alternate, or candidate returns the campaign
contribution within 30 days of learning about both the contribution and the proceedings.
This form should be completed and filed with your application or with the first written document you file or submitted after
the proceeding commences.
1.
A proceeding involving “a license, permit, or other entitlement for use” includes all business, professional, trade and
land use licenses and permits, and all other entitlements for use, including all entitlements for land use; all contracts
(other than competitively bid, labor or personal employment contracts) and all franchises.
2.
Your “agent” is someone who represents you in connection with a proceeding involving a license, permit or other
entitlement for use. If an individual acting as an agent is also acting in his or her capacity as an employee or member of
a law, architectural, engineering, consulting firm or similar business entity, both the business entity and the individual
are “agents.”
3.
To determine whether a campaign contribution of $250 or more has been made by you, campaign contributions made
by you within the preceding 12 months must be aggregated with those made by your agent within the preceding 12
Campaign contributions made to different
months or the period of the agency, whichever is shorter.
commissioners/councilmembers, their alternates, or candidates are not aggregated.
This notice summarizes the major requirements of Government Code Section 84308 of the Political Reform Act and 2 Cal.
Adm. Code Sections 18438-18438.8. For more information, contact the Campbell City Attorney at (408) 866-2125, or the
Fair Political Practices Commission, 428 J Street, Suite 800, Sacramento, CA 95814, (916) 322-5901.
Prepared by: Legal Division, Fair Political Practice Commission, May 1986
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Attachment B
Contribution Disclosure Form
Page 2
TO BE FILLED OUT BY APPLICANT
I.
[
II.
TO BE COMPLETED ONLY IF CONTRIBUTIONS TOTALING $250 OR MORE HAVE BEEN MADE.
]
IF CONTRIBUTIONS TOTALING $250 HAVE NOT BEEN MADE, CHECK HERE, AND SIGN
BELOW IN SECTION III.
NAME:
ADDRESS:
ZIP:
TELEPHONE NO:
LIST COMMISSION MEMBER(S) TO WHOM YOU AND/OR YOUR AGENT MADE CAMPAIGN
CONTRIBUTIONS TOTALING $250 OR MORE, AND THE DATES OF THOSE CONTRIBUTIONS.
NAME:
CONTRIBUTOR:
(if other than yourself)
DATE (S):
AMOUNT (S):
NAME:
CONTRIBUTOR:
(if other than yourself)
DATE (S):
AMOUNT (S):
NAME:
CONTRIBUTOR:
(if other than yourself)
DATE (S):
AMOUNT (S):
III.
SIGNATURE
DATE:
Signature of Applicant/Agent
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Attachment C
Hazardous Waste & Substance Sites Disclosure Form
This form must be completed by development applicants per the provisions of Government Code
Section 65962.5.
As part of the development application process, you must complete this disclosure form, certifying that
you have reviewed the current CAL-EPA Department of Toxic Substances Control Facility Inventory
Data Base Hazardous Waste and Substances Sites List (available at the Planning Department, City of
Campbell) and indicate below whether your project site is included on this list.
Project Site Address:__________________________________________________________________
Proposed Project:_____________________________________________________________________
Yes, the above-referenced site is included on the CAL-EPA Department of Toxic Substances
Control Facility Inventory Data Base Hazardous Waste and Substances Sites List.
No, the above-referenced site is not included on the CAL-EPA Department of Toxic Substances
Control Facility Inventory Data Base Hazardous Waste and Substances Sites List.
Applicant Signature___________________________________ Date___________________________
Please provide this completed form to the City of Campbell, Planning Department, 70 N. First Street,
Campbell, CA 95008, together with the application for development.
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Attachment D
West Valley Sanitation District 4 Acknowledgment
NOTICE TO APPLICANTS
REGARDING EFFECT OF WASTE WATER
TREATMENT CAPACITY ON LAND
DEVELOPMENT APPROVALS PURSUANT TO
DEVELOPMENT OF APN:
Please take notice that no vested right to a building permit shall accrue as the result of the granting of
any land development approvals and applications. Pursuant to the adoption of Ordinance 9.045 by West
Valley Sanitation District 4, the agency providing the above described parcel(s) with sewer service, if
the District’s Manager and Engineer makes a determination that the issuance of a sewer connection
permit to a building, or proposed building, on the above described property, will, in his opinion, cause
the District to exceed its ability to treat adequately the waste water that would result from the issuance
of such connection permit, then said permit may not be issued, and, hence, no building permit may be
issued by this agency.
If the sewer connection permit is issued, it may contain substantive conditions designed to decrease the
waste water associated with any land use approval.
ACKNOWLEDGEMENT
By signing below, the applicant acknowledges, at the time of application, that he/she fully understands
the above.
Address of Proposed Development
Applicant’s Signature
Distribution
Original to:
Copies to:
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Date
West Valley Sanitation, District No. 4
100 East Sunnyoaks Avenue
Campbell, CA 95008
File
Applicant
Attachment E
Environmental Information Form
(To be completed by applicant)
Date Filed_____________________
GENERAL INFORMATION
1. Name and address of developer or project sponsor:________________________________
_________________________________________________________________________
2. Address of project:__________________________________________________________
Assessor’s Block and Lot Number: _____________________________________________
3. Name, address and telephone number of person to be contacted concerning this project:
_________________________________________________________________________
4. Indicate number of the permit application for the project to which this form
pertains:________
_________________________________________________________________________
5. List and describe any other related permits and other public approvals required for this
project, including those required by city, regional, state and federal agencies:
____________
_________________________________________________________________________
_________________________________________________________________________
6. Existing zoning district: ______________________________________________________
7. Proposed use of site (project for which this form is filed):____________________________
_________________________________________________________________________
PROJECT DESCRIPTION
8. Site size:__________________________________________________________________
9. Square footage:____________________________________________________________
10. Number of floors of construction:_______________________________________________
11. Amount of off-street parking provided:___________________________________________
12. Attach plans:_______________________________________________________________
13. Proposed scheduling:________________________________________________________
14. Associated project:__________________________________________________________
15. Anticipated incremental development:___________________________________________
16. If residential, indicate the number of units, schedule of unit sizes, range of sales prices or
rents, and type of household size expected:______________________________________
_________________________________________________________________________
17. If commercial, indicate the type, whether neighborhood, city or regionally oriented, square
footage of sales area and loading facilities:_______________________________________
_________________________________________________________________________
18. If industrial, indicate type, estimated employment per shift and loading facilities:__________
_________________________________________________________________________
_________________________________________________________________________
19. If institutional, indicate the major function, estimated employment per ship, estimated
occupancy, loading facilities and community benefits to be derived from the
project::___________________________________________________________________
_________________________________________________________________________
20. If the project involves a variance, conditional use or rezoning application, state this and
indicate clearly why the application is required:____________________________________
_________________________________________________________________________
_________________________________________________________________________
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Attachment E - Environmental Information Form
Page 2
Are the following items applicable to the project or its effects? Discuss below all items checked
yes (attach additional sheets as necessary).
Yes
21
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
No
Change in existing features of any bays, tidelands, beaches or hills or
substantial alteration of ground contours.
Change in scenic views or vistas from existing residential areas or public
lands or roads.
Change in pattern, scale or character of general area of project.
Significant amounts of solid waste or litter.
Change in dust, ash, smoke, fumes or odors in vicinity.
Change in ocean, bay, lake, stream or ground water quality or quantity
or alteration of existing drainage patters.
Substantial change in existing noise or vibration levels in the vicinity.
Site on filled land or on slope of 10 percent or more.
Use or disposal of potentially hazardous materials, such as toxic
substances, flammables or explosives.
Substantial change in demand for municipal services (police, fire, water,
sewage, etc.).
Substantially increase fossil fuel consumption (electricity, oil, natural gas,
etc.).
Relationship to larger project or series of projects.
Additional traffic generation or parking demand.
ENVIRONMENTAL SETTING
34. Describe the project site as it exists before the project, including information on topography,
soil stability, plants and animals, and any cultural, historical or scenic aspects. Describe any
existing structures on the site and the use of the structures. Attach photographs of the site.
Snapshots or Polaroid photos will be accepted.
35. Describe the surrounding properties, including information on plants and animals and any
cultural, historical aspects. Indicate the type of land use (residential, commercial, etc.),
intensity of land use (one-family, apartment houses, shops, department stores, etc.), and
scale of development (height, frontage, set-back, rear yard, etc.). Attach photographs of the
site. Snapshots or Polaroid photos will be accepted.
36. Are there currently any other development applications associated with this property (i.e.
Site and Architectural Review, Planned Development Permit, etc.). If so, please list them.
CERTIFICATION
I hereby certify that the statements furnished above and in the attached exhibits present the
data and information required for this initial evaluation to the best of my ability, and that the
facts, statements and information presented are true and correct to the best of my knowledge
and belief.
Date:________________________
Signature:_____________________________________
For:__________________________________________
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